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The remarkable life of Dr Robert Schaller

2017; Elsevier BV; Volume: 213; Issue: 5 Linguagem: Inglês

10.1016/j.amjsurg.2017.03.008

1879-1883

Preston L. Carter,

Advances in Oncology and Radiotherapy

Today we honor the memory of the late Dr. Robert T. Schaller, an especially distinguished member of the NPSA Seattle caucus, and a gifted pediatric surgeon at Seattle Children's Hospital. During many decades of practice there, he cared for many thousands of patients and their families with uncommon clinical commitment, technical craftsmanship, and diagnostic acumen. His natural charisma, together with an infectious enthusiasm for teaching made participation in his cases a rewarding experience for all. He saw learning opportunity in even the most mundane of cases, signing many op reports with the notation, “AGC”, shorthand for “another great case”! His passion for intraoperative photography was legendary. Long before digital photography made surgical Kodachromes obsolete, his OR teams knew to keep his camera close-by to allow him to add more images to an ever-burgeoning slide collection. Rob's medical pedigree was impeccable. Born during the Great Depression in a small upstate New York town near Buffalo, his family later moved to Michigan, where he was an outstanding high school athlete. Later, at Yale he was selected captain of the track team. Originally interested in astronomy, he was encouraged to consider medicine instead, and went on to Harvard Medical School, reportedly fainting at his first sight of an actual procedure! Thankfully, he remained interested in surgery. In 1960, he moved west to begin surgical training at the University of Washington. Proximity to the glaciated wonders of Mount Rainier led him to a lifelong mountaineering passion. While still a resident, he summited many of the major glaciated peaks in the Northwest, and even found time to climb the 20,320 foot Mount McKinley (now Denali), North America's highest peak. After completion of residency and a three year tour at Madigan Army Hospital as a Berry Plan surgeon, Rob secured a coveted fellowship in pediatric surgery at Great Ormond Street Hospital in London, after which he began practice at Seattle Children's Hospital, where he remained for the duration of his career. In an era of ever-narrower surgical sub-specialization, Rob's skills allowed him to operate successfully on a host of patients with a wide variety of complex problems. While one could dwell on his many surgical feats, in remembrance it is also important to recall two other unique facets of his life, namely his prowess in track and his incredible climbing and expedition physician experiences in the Himalayan mountains. As mentioned previously, Rob was the captain of the 1956 Yale track team. This honor was in no small way earned by his having almost been the first man to run a sub-four minute mile, then considered a near-impossible barrier. Although Roger Bannister of Great Britain was the first to reach this milestone, Rob was himself a great miler, with a best time of 4:01. Had Rob had been first, his name rather than Bannister's would likely be the one remembered in the annals of track history. In mountaineering, Rob participated in two great high-altitude adventures, of which one was a top-secret national security mission. In 1964, Red China, as it was then known in America, detonated an atomic bomb in a desert near northern India. In America, there was great fear and distrust of Chinese intentions. Spy options were few. Satellites of the time were primitive. Further, as Russia had downed a U-2 spy plane not long before, with subsequent political debacle and show trial for the captured pilot, overflight options were unwise. Instead, the CIA conceived a covert plan, “Operation Hat”. The plan was to monitor Chinese nuclear test area communications from a plutonium-powered listening device placed high on a nearby Himalayan peak. One of India's highest mountains, Nanda Devi, was selected. Elite American and Indian mountaineers were chosen to pack the mini-reactor and associated components to a location near Nanda's summit, assemble the apparatus, and pray that it would all work out! In consideration of his dual abilities as an experienced glacier climber and a capable surgeon, Rob was invited to join the CIA team. Having been briefed on the plan's outlines by an undercover agent, Rob jumped at the chance. Unfortunately, although it may have been a “splendid little adventure” for many participants, Operation Hat was to be an operational fiasco. Despite diligent preparations, including a practice set-up (without the plutonium!) on Mount McKinley, the plan was doomed by the fickle Himalyan climate and daunting terrain. Although the necessary gear was successfully carried to a high shoulder on Nandi, severe storms and the approach of high-altitude winter conditions prevented its final assembly. It was decided to cache the device on the mountain, reactor and all, to await better conditions the following Spring. However, when the climbers returned, they discovered to their dismay that the cache – and the Plutonium reactor - had been swept away in a major avalanche, and was now somewhere far down the mountain, deeply buried in rubble. It also turned out that the watershed of Nanda Devi was part of the headwaters for the Ganges river, and there was fear that these sacred waters might become poisoned. This led the CIA to heroic secret efforts to recover the missing reactor, reminiscent of “Indiana Jones and the Raiders of the Lost Ark”. Ultimately, recovery proved impossible, and while the risk of watershed radiation contamination was ultimately judged to be miniscule, the buried generator lies somewhere on Nanda Devi to this day! Over time, the facts surrounding Operation Hat gradually became known in the public domain, but at the time the entire team was sworn to secrecy, forcing Rob to keep it all under his own hat for decades, so to speak. My last vignette of Rob takes place on K-2, in the Pakistan's Karakoram range and the world's second-highest mountain. In 1975, he was invited to be both a climbing team member and expedition doctor on a group seeking to make the first American ascent of K-2. Although only slightly lower in elevation than Mount Everest, K-2 is much more remote and technically difficult. To many elite mountaineers, it is irresistible. The 1975 team included the legendary mountaineering brothers, Jim and Lou Whittaker, and. Jim Wickwire, another well-known American mountaineer and Rob's partner from an earlier Mount McKinley climb, when they were among the first to reach the top “alpine style”, a bold strategy whereby tents are foregone, only the bare essentials are carried, and any necessary shelter is sought in glacial crevasses or favorable local rock formations. Considering McKinley's subarctic location and well-deserved reputation for prolonged bad weather, this climbing success was no mean feat. The 1975 K-2 climb was defeated both by fickle weather and a route plan which proved technically impossible. Three years later another expedition was formed, again including Wickwire and Rob. Arthritic aftereffects of old knee surgery limited Rob on this climb to a lower elevation support role, but he was kept busy nonetheless with his responsibility as expedition doctor, including ministering to some challenging medical needs of the expedition's porters. Four members of the 1978 team ultimately reached K-2's summit, two each on successive days. While the second day's climbers summited in unusually fine weather, on the first summit day Wickwire and his partner had far less favorable conditions, and were unable to reach the summit until very late in the afternoon. On the descent, Jim ran out of daylight and was forced to bivouac in bitterly cold conditions near the summit, often a fatal scenario. Perhaps his prior McKinley alpine-style experiences with Rob helped him survive the long night, but he did not escape unscathed, suffering extreme dehydration and frostbite, as well as the inevitable generalized physical deterioration which takes place above 20,000 feet, known to climbers as the “death zone”. Staggering into base camp with bloody sputum and difficulty breathing, Jim was still in serious trouble. Rob diagnosed pneumonia and a probable pulmonary embolus, and supervised major resuscitative efforts. Jim's condition stabilized, and Jim and Rob were evacuated by high-altitude helicopter rescue. After return to Seattle, Jim required thoracotomy and decortication to repair the pulmonary damage, fortunately with eventual full recovery. After the K-2 climb, Rob turned more attention to the demands of his surgical practice, carrying on a long and rich career. As is true of many driven surgeons, it was sometimes a struggle to balance demands of a surgical practice on the one hand, and his family's need for him on the other, not to mention the challenge of finding time for his many other interests. As surgeons, many of us can sympathize with this difficult balancing act. For this former gifted athlete, it is ironic that Rob's mobility became severely limited in his later years by the capricious nature of the aging process on spine and joints. Fortunately, his mind remained sharp, and well past retirement he continued to teach residents part-time. In those difficult final years, I hope he found comfort in the gratitude of former patients, the respect of his medical and climbing colleagues, and not least, in the support of his wife, Trese, and their children, as well as other children from earlier marriages. Vignettes such as this are necessarily limited in scope and far from a biography. I hope that I have been able to convey some insight into the life of this talented, kind, and gentle surgeon. I am proud to claim him as one of my most valued mentors in my own residency. A final memory of Rob: In 1965, during the CIA's search efforts for the missing reactor on Nanda Devi, a cloudless, windless day offered Rob and one of his fellow climbers a rare summit opportunity. Rob's partner was overcome by altitude effects and turned back partway. Now solo, Rob soldiered on in treacherous conditions of snow and scree, and reached the summit, in the first solo ascent of this high peak. It was then the highest solo ascent of any mountain by an American, an extraordinary accomplishment. In a later account, he described resting on top, exhausted but also elated, and taking a 35 mm “selfie” (as we now call it) with his trusty camera. To his lasting chagrin, however, on return to base camp, the CIA confiscated his film, as well as his personal climbing diary. Decades later - and even after knowledge of this cloak-and-dagger saga became public knowledge - the government refused his requests for their return. In the end, Rob's efforts to overcome an obstinate government bureaucracy proved impossible! Regarding the significance of individual lives, Daniel Henninger, an insightful and longstanding columnist for the Wall Street Journal, once wrote:Each person's life is a galaxy of thoughts, sights, conversations, acts, and decisions that ripple outward, touching other beings who in their turn and by their lights react somewhere along the infinite gradient of conscious life that is our unique gift, perhaps from God.1Henninger Daniel Quoted from column “Wonder land”.Wall Street Journal. November 2, 2001; Google Scholar This sentiment perfectly reflects the impact of Dr. Schaller's long and fruitful life on those around him, whether they be family, friends, climbing companions, and certainly not least, his many patients and their families. He was certainly one of the most valued and influential mentors in my own residency. It has been my privilege to remember him today. May he always rest in peace. I am grateful for the kind support and insights of Rob's widow, Ms. Trese Rand, and his friend and longtime climbing companion, Jim Wickwire.